Are Doctors Rich?

(Part of an ongoing series Should I Become A Doctor?)

People rarely ask about income directly, but Doctor D gets a lot of wink-wink nudge-nudge questions about his finances such as,

“So what you drive, doc, a BMW?”

or

“It’s hard making ends meet sometimes, but you wouldn’t know about that, would you doc?”

So to answer your questions Doctor D will throw open the doors to the secret realm of physician personal finance:

"Where'd I get the money? Med School, Bitches!"

Last year Dr. D made about 150,000 dollars, which is a lot of money. (The Medical Mafia makes sure MD's get paid well in exchange for our souls!) Uncle Sam and student loans took a pretty large chunk of that, but still Doctor D has more than every non-medical person he knows, and he is a Primary Care Doctor, which is one of the lowest paying specialties!

Now before you start filling out medical school applications dreaming of big money let me warn you about the downside: You spend about a decade of your life working for free and amass a mountain of debt to get here.

Dropping Out and Adding Up

Everyone considering the financial benefits of medical school should calculate their drop-out sibling equation:

Doctor D has a brother about his age. Brother D was a smart dude, but he never liked school so he dropped out in high school. Brother D immediately started making money working at low-skilled but steady jobs while Dr. D was toiling away at medical education.

Brother D’s lifetime earning was very gradually rising while Dr. D’s debt was increasing, until one day Dr. D started making big bucks. Dr. D and Brother D sat down and did the math problem.

The answer: 41

Doctor D will be 41 years old before his MD catches up with his drop-out brother's GED in lifetime income!

Our paths diverged at about 17 years old. Doctor D is 32 now so he has another 9 years till he’s made as much money in his life as Brother D.

Medical School isn’t exactly the quick way to riches.

But in this economy who can complain about making six figures? Doctors do it all the time, but nobody is listening.

Doctors work hard and we get rewarded. It just isn’t as rewarding as some pre-med students and patients think.

"You know you laidies can't resist!"

By the way, Dr. D drives the cheapest car Toyota makes—it’s the first new car he ever owned.

What do you think?

Pre-meds and Med Students: Did the financial rewards of affect your career choice?

Patients: Do you think income differences between you and your doctor harms your doctor-patient relationship?

Doctors: Are you satisfied with your income? Do you feel you deserve more or less?

Doctor D always loves to read your thoughts in the comments.

I Hate Medicine!

Last week Ella the Med Student wrote brilliant and thoughtful advice on how to be happy in medical school: You need to love medicine.

Now Doctor D has a confession to make:

I hate medicine! Medical school was the worst 4 years of my life.

There, I said it! It felt good to let it out.

But before all of Dr. D’s medstudent fans rush to unfriend him on facebook they should know this: Doctor D not just a good doctor. He is a frickin’ amazing doctor!

How is this possible?

They look so pleased just to be in a hospital!
Doctor D isn't in any photos like this.

How I Learned to Stop Worrying and Hate Medicine:

Ella classified medical students based on their love for medicine with the “miserablites” at the bottom. They are the ones in medicine with ulterior motives. Therefore they hate school from the first cut on the cadaver. They don’t fit in with other medical folks. They don’t like studying diseases or treatments. They can’t wait for medical school to be over.

Yup, that pretty much describes D in medical school!

Young D took one of those aptitude tests administered by the college career counselor. It said that his personality was an awful fit for doctoring. He was warned.

So why did he do it?

Medical School With Ulterior Motives

Doctor D’s ulterior motive for studying medicine was that pesky humanitarian impulse. D loves people. As a student young D worked in homeless shelters and volunteered in 3rd World countries—not to pad a resume for med school, but because he actually liked doing those things. Young D asked himself, “Self, what work should you choose that allows you to help suffering people?” Since D had the book smarts everybody suggested medicine.

On day one of medical school D realized he wasn’t in Kansas anymore. He was surrounded by highly driven people who absolutely loved spending 18 hours a day studying pathophysiology and pharmacokinetics. Ella enjoys kicking back with Robbins Pathology while sipping her coffee in the morning. God bless her crazy ass! Doctor D’s trudge through Robbins was about as enjoyable as the Bataan Death March.

D’s secret fantasy in medical school was that one day he’d go in and give everyone the middle finger and drop out. This thought was the only real pleasure he had for most of med school. It kept him going when times got rough. Every miserable day D told himself, “I’ll quit tomorrow.” He came close to doing this about a hundred times, but never pulled the trigger.

Doctoring with Love and Hate

So D became Doctor D, and lo and behold he was right: All this dull medical science he forced himself to learn is useful—it helps sick people get well, and D really enjoys his job!

The actual practice of medicine allows for amazing connection with other human beings. A caring doctor during the worst and most painful day of your life is really useful. Doctor D always gets along well with patients. One reason Dr. D connects so well with patients is that he never really did connect with other medical folks.

Some doctors love studying diseases and reading the latest medical trials—quite a few retired docs do this years after they’ve seen their last patient. That’s cool and all, but it ain’t me. If Doctor D lost his medical license tomorrow you can bet he wouldn’t read another sentence of medical literature again!

"Yeah, I don't like school either, but some things are worth the misery."

But Doctor D does keep up with all the info on the escalating arms race between diseases and medicine and he'll treat you with just as much skill as the next doctor. In some ways D sees himself as the purest form of doctor:

Some doctors battle illness because they are fascinated with the weapons or with the battle strategy. Doctor D fights because he believes in the cause.

So take courage you med school miserablites—you sad souls who don’t like biochemistry or fit in with your anal classmates—here is hope for you yet! You may yet become a fine MD who loves this crazy job in a way those medical types could never imagine.

PS: If any of you med students do decide to go out in a blaze of glory by telling "the man" to stick it up his rectum and burning your student ID please email Dr. D your story because he would love to live that moment vicariously!

An informal AskAnMD poll:

How many of you medical people actually like medicine vs. those who use medicine for ulterior motives like Dr. D?

How many of you patients would care if you doctor wasn’t actually fascinated with your disease and your medicines?

The Medical Life (Friday Links)

The blogs of health workers can be a fascinating peak into the minds and motivations of those of us in medical life. I enjoy the funny or amazing true stories on blogs as much as the next guy, but what's really interesting to me are the lives of people who choose to work with sickness and suffering every day.

Judging by the number of TV shows on us it appears that the public at large is fascinated with medical students, nurses, and doctors too. Truth be told, we aren't as good looking, dramatic, or perfect as our TV counterparts. We are normal people, but personally I prefer real people over stock characters with stethoscopes.

One of my favorite nurse bloggers, Maha, used the turn of the decade to tell the fascinating and personal story of her life over the last 10 years. Her personal growth during her journey to become an ER nurse is very interesting reading. Behind the sharp wit and toughness there is a humanity and sensitivity that makes her blog one of the best out there.

I found another glimpse into the personal motivations for a medical life over at Asystole Is The Most Stable Rhythm. Besides having the coolest blog name ever AlbinoBlackBear has some great stories. Her encounter with a dying child years ago as a nurse left her wondering if healthcare was a good choice for her. The answer was yes and now she is in medical school. Asystole is a wonderful med student blog and I can't believe it took me this long to find it.

So what leads people to choose a medical life?

Ella the med student and Old Girl both followed Maha's lead and posted their own biographies of 2000 to 2010. Doctor D shall follow in the footsteps of these great bloggers and give you a brief picture of how he has transformed over the last decade:

At the dawn of 2000 young D was a college senior applying for medical school. He was a bold, iconoclastic idealist who was certain he would save the world. Young D wore a long beard with long hair and was certain that human suffering was a puzzle that could be fixed if people just cared enough to help others. He figured that medicine was the highest and purest calling a person could choose for their life.

Then came reality: years of medical school, followed by years of residency, followed by the ultimate goal—being a "real doctor."

After a decade of ceaseless work I no longer think I am going to save the world. I have saved a few lives, but it was by doing my job not through any heroism. Jesus may save the world, but doctors and nurses certainly won't. We simply do our jobs day in and day out.

In the end, the medical life is a life like any other. It isn't always fun or sexy. We are not so brilliant or so heroic. We are humans who take care of humans, so our work is fraught all those troublesome human complications. Some days we love our vocation and some days we want to quit, but we do our best because we care about our patients.

In 2010 Doctor D is more tired and less idealistic. These days D is more more proud to be Ms. D's husband and Little D's dad than he is about that MD he spent so many years dreaming about.

What do you think? Did you imagine doctor's lives to be more heroic and dramatic? Do you work in healthcare and have a story about your own medical life to share? Doctor D always enjoys the perspectives and stories you tell in the comments.

Why Do Incompetent Doctors Flourish?

Last week Doctor D answered this question in a way that made him sound like a frickin' hero:

How do doctors deal with colleagues that they know are incompetent?

Now that you all think I'm awesome, I have to make a confession: I have looked the other way a lot more often than I have saved the day.

Doctor D has known some bad doctors over the years. I don't mean doctors that make errors—we all do that sometimes—but doctors that flagrantly disregard patient safety and don't give a damn about right practice. And Doctor D usually kept his mouth shut.

The code of silence started early...

Doctor D's first run-in with reckless care was as a first year med student. D was working with Dr. Subethical who happened to teach the medical ethics class. Dr. Subethical who seemed so cool in class spent most of his clinic time screaming at patients and dictating physical exams he didn't perform. Lowly Medical Student D thought that this didn't seem right, but he never confronted Dr. Subethical or filed any complaint. Young D figured he must have just misunderstood the situation. Also Dr. Subethical was an honored professor while D was just some lowly student who didn't want a target on his back.

MD's usually have more power and more knowledge than their patients and other healthcare providers. This often keeps patients, med students, and nurses from confronting doctors. So it falls on other doctors to keep an eye out for bad care among our colleagues.

Unfortunately, we doctors do a terrible job policing each other.

Young D always kept his mouth shut in medical school, but he told himself that when he got that MD with some power and knowledge he would set the world right. He would stamp out crappy care and save the world from low-life doctards! Yeah, well old habits stuck around. D's been out of medical school for a long time now, and has seen quite a few doctards, and his number of confrontations thus far is a grand total of... one! To be honest, Doctor D only whooped some doctard ass at Crayzee Clinic after having incompetent care shoved in his face month after month till he couldn't ignore it anymore.

So in this anonymous blog Doctor D confesses:

"Hi I'm D, and I have turn a blind eye to bad medical care."

Doctor D's readers all gasp and shake their heads.

"But wait, I can explain!"

There are lots of reasons good doctors are always letting the bad ones off the hook:

• Nobody Likes Tattletales: You might assume that Doctor D's heroic battle with Crayzee Colleague looks good on his resume. Nope! D has a big FAIL stamped right across his forehead. Nobody wants to work with a goody two-shoes who rats out his buddies when they break the rules. Even the excellent docs got kinda distant while I was fighting Crayzee Colleague. If I called out bad doctors wherever I worked before long I wouldn't have a job.

• Nobody's Perfect: Our culture expects perfection from doctors. Of course, we all make mistakes, and many of us live in dread of errors. We want people to forgive our mistakes so we are willing to accept that other docs make errors too. Now there's a big difference between understandable human error and the doctard who makes a habit of flagrantly and willfully doing stupid shit. Unfortunately, this unspoken "culture of forgiveness" in medicine protects the guilty as well as the innocent

• Everybody Hates Lawyers: Every MD lives in constant fear of a malpractice case, which is a professional and personal catastrophe. We usually keep our mouths shut about bad care because discussing possible malpractice is taboo. If you accuse a colleague of malpractice you might as well send the poor schmuck in front of a firing squad. There just isn't any safe environment where we can confront other physicians. It's ether shut your mouth or throw your colleague to the dogs.

• There's More Than One Way To Skin A Cat: Every doc remembers that abusive attending in medical school that yelled that there was only one right way do do medicine, which happened to be his way. Later we learned there are a lot of different right answers in medicine. Every doc has a different treatment style. Nobody wants to grow up to be that jerk that attacked others' legitimate care because it wasn't the way he did it. So sometimes when we see obviously bad care we shrug and say, "Well that's not what I would do, but maybe it's just a different approach?"

• Second Hand Information: Most of the bad care I know about is hearsay. I usually don't have time to sit around and watch my colleagues practice. I hear things from patients or read charts that sound concerning, but I wasn't there. I tend to give other doctors the benefit of the doubt: "Maybe there's a good explanation for this?"

• We Expect Lawyers To Do Our Dirty Work: Every good doctor can probably think of an incompetent doctard who they secretly hope will get destroyed in a malpractice lawsuit. (Yep, Doctor D is thinking of one right now.) Malpractice is horrible, but some doctors deserve it. Why should we waste our time confronting bad care when lawyers will take out the garbage for us? Unfortunately, this is a total cop out. Malpractice does a terrible job policing medicine. First of all, the lawyers and juries don't understand medical care very well. Second, lawyers don't bring malpractice cases to improve medical care. Lawyers bring malpractice cases to hit the jackpot. The malpractice system creates a mad scramble where big money gets awarded or denied based on the lawyer's cleverness or the jury's mood, rather than the doctor's competence. Good doctors are often screwed while bad doctors get off on legal technicalities. Malpractice doesn't really improve medical care—it just makes doctors afraid to discuss bad care.

Of course, all these are just lame excuses. Doctors should step up and call out the bad ones who are endangering patients. Doctor D can think of a couple that need to be set straight, but after his adventure at Crayzee Clinic he isn't too eager to try any more heroics. He's keeping his mouth shut and venting anonymously on his blog.

So Doctor D has taken the first step: he admitted he has a problem. Any ideas for 11 more steps that could motivate D and the other good doctors out there to remove the incompetent doctors from their midst? I've got no answers on this one.

This is an intervention!
Your favorite blogging doctor has a serious apathy problem, but he is totally unmotivated to change. Use the comments section below to convince Doctor D why he try to be a hero again when the first time was a big fail!

Primary Care: The Best and Worst Job in Medicine

Shawn the medical student asked Doctor D:

As a medical student, I am constantly wondering what type of physician I will become. So my question is, what kind of doctor are you, and how did you decide that field?

Doctor D is a Family Medicine doctor. He chose this career because he is a glutton for punishment! Actually, D chose Family Med because he likes people much more than he likes the technical aspects of medicine. As a jack-of-all-trades doctor I can usually help anyone no matter their age, gender, or medical history, but my knowledge on any specific subject is limited. I can sew up lacerations, give end of life care, deliver babies, prevent future illness, and educate people on how to handle most common medical problems. I did this because I enjoy working with human beings and want to help people with their physical needs.

Should you choose Family Medicine as your specialty you will be constantly looked down upon by other physicians. Even though you probably store more knowledge in your brain than any other doctor, specialists assume you are slow-witted because you don't know as much about their particular disease of choice as they do. You will make much less money than other doctors because insurance doesn't think keeping someone healthy is nearly as worthwhile as doing big tests and procedures. You will constantly be pressed to see more patients in less time because the reimbursement for your work is continually dropping.

After his training Doctor D chose to work in a community health clinic to provide primary care for underserved patients. He absolutely loved his job and the amazing people he cared for. He also learned to hate the medical system and the bean counters that were constantly pushing him to cut corners on patient care. In the end the bureaucrats won and Doctor D quit that clinic rather than choose to hurt the patients he cared about. He is currently working odd shifts as an ER doctor in a tiny hospital in the middle of nowhere to pay the bills till he returns to Primary Care. He blogs about patient-doctor relationships because he misses having patients of his own and still has those crazy ideas about "helping people" with his medical knowledge.

Of Course there are days Doctor D wishes he would have never signed on to be a general doctor (or a doctor at all for that matter). But when I realize I can help nearly every person that walks through my door I am certain that I chose the right career. Family Medicine is one of the most frustrating and rewarding paths in all of medicine. I advise med students to seriously consider general primary care—it is the fullest embodiment of the ideal of doctoring—but only select it as your specialty if you are certain you will love it, because it will probably get harder for primary care doctors before it gets better.

Wow, that was a touchy-feely post! I'm afraid Nurse K is failing to make a good hard-ass ER doc out of me. Quick, someone ask a question that will awaken my god-complex angry doctor side!